Posted by bleauberry on December 28, 2009, at 17:20:12
In reply to savella question, posted by floatingbridge on December 28, 2009, at 15:26:40
As I've said several times in recent months, I am a fan of Savella. However, that comes with some stipulations.
I do believe recommended doses are too high...at least as a guideline they are. For example the starter pack has 12.5mg and 25mg pills in it, ramping up very rapidly from 12.5mg once a day to 100mg (50mg twice a day). Why not just stay at 12.5mg and see what happens? Maybe it's just me, but I totally disagree with the whole predetermined schedule thing. They kind of have to do that in a clinical trial, but in the real world I think the rules have to change. How do we know that some of the dropouts and failures in those clinical trials weren't because the doses were ramped up too fast or too high?
My best dose, considering the profound urinary side effects I had balanced with therapeutic benefit, was 6.25mg three times a day. At just two weeks I was a ton better than before. This after ECT failed. That says something.
Trials have shown that low doses can work as good as high doses, but...they take longer. They'll still get you there, just not as fast.
My other stipulation with Savella is that it is best in a combination, not as monotherapy. I see it mixing well with any SSRI or TCA or antipsychotic. As clinical case studies at pubmed have shown it does. As Japan's practice shows it does.
All that said, yeah, Savella is a contender for your symptoms. But so is Cymbalta or Nortriptyline or LDN or Advil/Tylenol combo. I am beginning to wonder if the combination of nortriptyline and savella might be real good, as nortriptyline could block some of the pressor response of the peripheral effects of savella.
I can't avoid saying, when there is a lot of pain present, one almost has to wonder where does it come from? No one really knows, but we can put our finger on three basic categories. 1-Inflammation; 2-infection; 3-low endorphins. I think 1 and 2 go together. Steps should be taken to rule those in or out. I've talked about that many times here. Endorphins can be raised significantly (3 fold) with LDN and/or low dose of D-phenylalanine or DL-phenylalanine. If the pain is accompanied by feelings of doom and emotional sensitivity, then according to Julia Ross that is a low serotonin and low endorphin symptom.
poster:bleauberry
thread:931267
URL: http://www.dr-bob.org/babble/20091227/msgs/931299.html